POS0280 EXCESS RISK OF ALL-CAUSE AND CARDIOVASCULAR MORTALITY IN FEMALES WITH GOUT – A PROSPECTIVE COHORT STUDY OF 105,502 WOMEN
Authors: C. Yokose, N. McCormick, N. Lu, A. Joshi, G. Curhan, H. Choi
Journal: Annals of the Rheumatic Diseases (2022)

Background Despite the disproportionately worsening disease burden of female gout in recent years 1 and its frequent associations with key cardiovascular risk factors (more often than male gout 2,3 ), there remains a paucity of specific data about female gout, particularly about its impact on mortality and fatal coronary heart disease (CHD). Objectives To prospectively examine the relation of female gout and risk of all-cause and cardiovascular and coronary heart disease-specific deaths. Methods Using data from the Nurses’ Health Study (NHS), an ongoing prospective cohort study in which female nurses in the United States completed detailed mailed questionnaires regarding their medical history, lifestyle, and other risk factors at baseline and every two years thereafter, we prospectively analyzed the relation between gout status at baseline and during the follow-up period and the risk of all-cause and cardiovascular mortality using Cox proportional hazards regression to adjust for cardiovascular risk factors such as comorbidities, body mass index, postmenopausal status, medication use, and dietary factors. Results The analysis included 105,502 women without gout and 1602 women with gout. Women with gout at baseline in 1982 tended to be older (mean age 54 vs. 50 years), and more likely to report a history of hypertension (44% vs. 22%), hypercholesterolemia (17% vs. 8%), and diabetes (11% vs. 6%). During 24 years of follow-up, we documented 15,255 deaths from all causes, including 3,128 deaths from cardiovascular disease (CVD) and 1,405 deaths from coronary heart disease (CHD). Compared to women without history of gout or CHD at baseline, the multivariable relative risks (RRs) among women with history of gout at baseline were 1.33 (95% CI, 1.21 to 1.46) for total mortality, 1.40 (95% CI, 1.17 to 1.67) for CVD deaths, and 1.49 (95% CI, 1.17 to 1.91) for fatal CHD (Table 1). The corresponding RRs for gout at baseline and during the follow-up were 1.33 (95% CI, 1.23 to 1.44), 1.43 (95% CI, 1.24 to 1.66), and 1.34 (95% CI, 1.08 to 1.66), respectively. Table 1. Relative Risks of Death from All-Causes, Cardiovascular Disease, and Coronary Heart Disease According to Gout Status at Baseline in 1982 in the Nurses’ Health Study No CHD No Gout Gout Deaths from all causes Cases, n 14,810 445 Age-adjusted RR (95% CI) 1.0 1.58 (1.43, 1.73) Multivariable-adjusted* RR (95% CI) 1.0 1.33 (1.21, 1.46) All cardiovascular deaths Cases, n 3,001 127 Age-adjusted RR (95% CI) 1.0 2.06 (1.72, 2.46) Multivariable-adjusted* RR (95% CI) 1.0 1.40 (1.17, 1.67) Fatal CHD Cases, n 1,335 70 Age-adjusted RR (95% CI) 1.0 2.53 (1.99, 3.22) Multivariable-adjusted* RR (95% CI) 1.0 1.49 (1.17, 1.91) *Adjusted for age (continuous), history of hypertension, history of hypercholesterolemia, history of diabetes, aspirin use (yes, no), diuretic use (yes, no), smoking (never, past, current &lt;15, current ≥15 cigarettes/day), body mass index (&lt;23, 23-24.9, 25-29.9, 30-34.9, ≥35), physical activity (quintile), alcohol intake (nondrinker, &lt;5, 5-9, 10-29, ≥30g/day), family history of MI (yes, no), menopausal status (premenopause, post menopause), hormone replacement therapy use (premenopause, never user, current user, past user). total energy intake (quintile), trans fat (quintile), dietary cholesterol (quintile), protein (quintile), linoleic fatty acid (quintile), and ratio of polyunsaturated fat/saturated fat. CHD = coronary heart disease; CI = confidence interval; RR = relative risk. Conclusion These prospective data indicate that women with gout have a higher risk of all-cause mortality, which is primarily driven by higher risk of CVD deaths. These findings closely agree with the UK general population data of both sexes that showed unclosing mortality gap over the past two decades. 4 Together, these findings provide support for rigorous cardiovascular risk factor modification specifically in female gout to help curtail the rising disease burden of gout worldwide. 1 References [1]Xia et al., PMID 31624843 [2]Puig et al., PMID 2012455 [3]Harrold et al., PMID 16644784 [4]Fisher et al., PMID 28122760 Disclosure of Interests Chio Yokose: None declared, Natalie McCormick: None declared, Na Lu: None declared, Amit Joshi: None declared, Gary Curhan Consultant of: AstraZeneca, Allena Pharmaceuticals, Shire/Takeda, Dicerna, and Orfan, Grant/research support from: Decibel Therapeutics, Employee of: Chief Medical Officer at OM1, Inc., Hyon Choi Consultant of: Ironwood, Selecta, Horizon, Takeda, Kowa, and Vaxart, Grant/research support from: Ironwood and Horizon